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Hyposplenism / splenectomy

Definition
  • Hyposplenism: Reduced splenic function, leading to diminished immune response against certain pathogens.
  • Splenectomy: Surgical removal of the spleen.
Causes of Hyposplenism
  • Autoimmune conditions: e.g., systemic lupus erythematosus (SLE), rheumatoid arthritis.
  • Hematological diseases: e.g., sickle cell disease, thalassemia, hereditary spherocytosis.
  • Infiltrative diseases: e.g., sarcoidosis, amyloidosis.
  • Post-splenectomy.
Indications for Splenectomy
  • Trauma with splenic rupture.
  • Hematological conditions: e.g., immune thrombocytopenia (ITP), hereditary spherocytosis.
  • Non-responsive splenomegaly.
  • Masses or cysts within the spleen.
Complications
  • Overwhelming post-splenectomy infection (OPSI): Severe infection due to encapsulated bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis).
  • Thromboembolism: Increased risk of portal or mesenteric vein thrombosis.
  • Atelectasis or pneumonia: Due to restricted diaphragmatic movement post-surgery.
  • Wound infection.
Investigations
  • Blood smear: Presence of Howell-Jolly bodies (nuclear remnants in RBCs) indicates hyposplenism.
  • Imaging: Ultrasound or CT scan for spleen size and morphology.
Management
  • Vaccination: Before elective splenectomy, vaccinate against encapsulated organisms (pneumococcal, meningococcal, and H. influenzae type b vaccines).
  • Consider prophylactic antibiotics post-splenectomy, especially in children and for at least 2 years after surgery or lifelong in certain cases.
  • Education: Advise patients about the risk of infection and to seek immediate medical attention for febrile illnesses.
Prevention
  • Vaccination is key for preventing severe bacterial infections.
  • Routine check-ups to monitor for complications.
  • Prompt treatment of infections with broad-spectrum antibiotics.

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